Social Phobia Treatments 1 Social Phobia Treatments Social phobia is a disorder that has cognitive and physical manifestations.

It is often considered extreme shyness. And people may experience it from a young age. Its when a person prefers to avoid social situations that cause them extreme discomfort and anxiety like, speaking in public, eating in public, meeting new people etc. It has recently started to be researched more thoroughly and these are some of the therapies that have been seen too make a positive change in people who suffer from it. Individual Therapy is alternative to treat Social Phobia. It could be possible to establish rapport and a trusting relationship that might benefit the person suffering from this disorder (Zal, 2003). It provides education about the interplay of psychological, behavioral and biological forces in social phobia. Associated issues of patients' low self-esteem, lack of assertiveness or feelings of inferiority that often accompany social phobia also can be addressed. (Zal, 2003) Saeed (2009) writes that individual therapy should be conducted but we should know that many people with SP are very sensitive to social situations and many of them have already had therapeutic experiences, mostly failed attempts to get better. Because of this the psychologist must be more careful and sensitive when treating people with social phobia. A substantial obstacle to receiving treatment for many people with social phobia is the discomfort they feel making contact with other individuals" (Curtis, 2004). Working with this population requires that the therapist try to understand what the client is going trough. A trusting and strong relationship must be established between therapist and client. In which the client must feel comfortable enough to express the feelings, vision and thoughts they experience when anxious. There must be clear goals and possible outcomes. Saeed (2009) also tells us that there must be education about the illness and what can be done to help. Treatment planning begins by discussing the benefits and risks of treatment options. Both clinician and patient must consider several factors that go beyond acute treatment success

Social Phobia Treatments 2 rates when selecting an approach. These decisions involve weighing the advantages and disadvantages of each treatment to see how well it matches a patient's presentation, severity of symptoms, degree of functional impairment, psychiatric and substance-related comorbidities, personal and financial resources, and preferences. (Saeed, 2009) But Zal (2003) cautions us that no matter with what type of therapy the therapist must understand that in social phobia or any phobic or anxiety disease the person might be reluctant or suffer from high anxiety during their therapy. Russell Curtis (2004) suggest that there are some key pointers that therapist must have in mind when trying to treat Social Phobia. The first is education. He says that educating the client, family and society about the illness, will help in the process of treatment. Social circles like school and the workplace should be places where there should be an effort to educate people about the symptoms and treatments for Social Phobia. He stresses that educating the client is crucial. The second is that therapist must be conscious about anxiety not only what the client experiences but that anxiety may be a reaction or symptom that is not part of social phobia. And it is important for the therapist to recognize these differences and to make sure that they are treating social phobia. The third is cognitive reconstruction and exposure to social situations that have caused discomfort to the person. This can be achieved with Cognitive-Behavioral Therapy and exposure therapy. Many techniques are used with these therapies like: role play, in vivo experiences, cognitive reconstructing, assertiveness training, role play, challenge. Cognitive therapy is one of the most recommended treatments for Social Phobia. This disorder has a big cognitive component. And this type of therapy deals with that psychological aspect of social phobia. In CBT the therapist and client examine and challenge irrational and

Social Phobia Treatments 3 anxiety causing thoughts. What they are looking for is to see if there fear is based on rational thinking and if not its about reconstructing these irrational thoughts. They achieve this with in vivo exposure. This could be done by role playing in the therapy session or by slowly exposing the client to anxiety causing situation. Social skills training, relaxation training etc are techniques that are worked on before exposing them too these situations. (Zal, 2003) Another therapy that has been proven to be effective in treating social phobia is Cognitive behavioral group therapy. Developed by Heimberg (2002, 1990);

The weekly group sessions include education; self-monitoring; exposure simulation by role-playing of anxiety-provoking events in the group; cognitive restructuring exercises before, during and after exposure; and both behavioral and cognitive homework assignments to practice new skills between sessions. Several studies have demonstrated the efficacy of CBGT for social phobia...(Zal, 2003). Also, Solution Focused Therapy. Developed by Shazer (1988) and is based on creating solution for the problems that people with Social Phobia confront. In this type of therapy the client builds solutions by recognizing the exception. In other words the therapist and client look into any given situation that causes anxiety for the person, and look to see if they were successful in surpassing their anxiety. If the answer is yes they look at what they did that made it successful for them. And then use this information to help them in other situations. If failed the therapist or client to not dwell on it in a manner that accuses the client of failing but instead they go back to looking for exceptions. This therapy is especially good for children, because it builds on the imagination and particular way the child views the world. It intends to accept the world the way the client sees it making a teamwork effort to look for solutions. This therapy is considered to be future and goal focused. They use questions of exceptions to negative situations to help the client understand what was done in the expectation situation that will help them in the future. It has positive reaction because it builds on the positive

Social Phobia Treatments 4 traits and responses from the client instead of the negative. Instead of asking why its asked when. For example if a person had a situation in where they did not manage their anxiety well the therapist might ask; When has there been a situation where you handled better? instead of Why do you think you did not handle it better? On the first one the therapist and the client can investigate how they were able to manage it and apply it for the next situation instead of dwelling on how and why they were not successful. George (2008) explains that; The exception question assumes that the client has already begun to find solutions without knowing it. And that is what the questions are there to explore. And by doing this the client starts to be aware. Awareness is very important in this therapy. Because the goal is to make the client aware of her or his strengths in the matter and to grow upon these. Another important technique is the miracle question. The client is asked to think about what type of miracle would occur that would help them not have the anxiety and fear they have. The miracle question promotes the change process because it gives the client permission to think about an unlimited range of possibilities. By focusing on the future, attention moves away from current and past problems and toward a more satisfying life (DeJong & Berg, 1998). (George, 2008). Other techniques include scaling questions and coping questions, that are again awareness techniques that guide the client into seeing that they have always had the tools to take control. George (2008) highly recommends SFT for children because it builds on the strength that they already have, raises awareness and is proven to help with behaviour modification issues. It also builds on the positive traits of the client and motivates the continued therapy for their mental disorder. Many researchers coincide that Social Phobia has indications of being cognitive disorder. Maladaptive thoughts that people may have, distorted thoughts about what people think of them and the fear of being humiliated can be treated. In this psychological aspect of the

Social Phobia Treatments 5 illness it is almost guaranteed that the on of the most effective treatments will be CBT (Cognitive-Behavioral Treatment). There have been many investigations comparing CBT to other therapies like, Exposure Therapy, Cognitive-Behavioral Group Therapy and Educational Support Groups. Furthermore it has been proven that CBT and ET combined is very effective in treating Social Phobia and other depressive or phobic illnesses. In a particular study that Curtis (2004) mentions CBGT was compared to ESG and was found that the both are successful in treating SP. The difference lies in how long the effects of this last. It was found that CBGT has longer standing effects in helping the symptoms of SP. This study clearly points to the importance of helping clients recognize and change irrational thoughts and face their fears, first in controlled role-play situations, and then gradually moving to more natural interactions (Curtis, 2004). In another study that Curtis (2004) mentioned CBGT and ET were compared. And found that together they're even more effective. Participants were divided in two groups. The first group were treated with ET and CBGT. And the second just with ET. The ET and CBGT combination showed particularly good responses. The combined group was taught how to reconstruct cognition and to challenge their irrational thoughts, and then were exposed to fearful situations. The ET group were exposed to fearful situations until they felt their fear was less. Both groups were successful in eliminating avoidance of situations. But 52% of the combined group against 17% of the ET were actually able to minimize there avoidance to certain situations and the ratings were still less. In other words he ET group although successful at the beginning of treatment after treatment it seems to decline. Furthermore, both groups demonstrated significant decreases in their avoidance of fearful situations between pre- and post test; however, the combination group's avoidance ratings continued to decrease, between the post treatment and the 3-month follow-up, while the ET group's avoidance ratings increased. Thus, it appears that teaching people with social

Social Phobia Treatments 6 phobia CBT strategies, in addition to having them engage in fearful situations, increases the likelihood that they will continue to improve once treatment is completed. (Curtis, 2004) In another study (Curtis, 2004) CBT and ET were compared in the same way. And was concluded that the combination of CBT and ET are more beneficial with the client. There is significant change in symptoms and it does not decrease. Whereas with ET alone there is improvement in the beginning but after a three month follow up it decreases. With CBT alone there is still a change but it is relatively slow but steady. Unlike Exposure therapy when followed up there seems to be long lasting improvement. Curtis (2004) says that family therapy combined with CBT also helps in treating social phobia specially for children. Also, in youth CBGT is very beneficial. Family therapy comprised twelve 40-minute sessions and consisted of assisting family members to work together as a team to help the client alleviate his or her anxiety. (Curtis, 2004) According to Sherry Boschert (2011) writes in Internet-based CBT works for depression, phobias, anxiety how CBT done via the Internet has improved people with Social Phobia and other anxiety disorders. It is the same techniques in traditional CBT but it is given via email. The therapist and client communicate with email and do all exercises. The results seem to last and the adherence to therapy is strong. Apart CBT another treatment that is often recommended and preferred is medications. As mentioned before medications have not been thoroughly investigated for social phobia specifically but has been for depression and other anxiety disorders. Saeed (2009) recommends that before considering medication for SP we must first investigate if the person suffers from generalized social phobia or circumcised social phobia. The first is when a person has the most strong effects of this illness and have possible comorbid diseases. The last one is when people only get some of the symptoms, like stage fright. These last ones could be treated with medication in a need basis.

Social Phobia Treatments 7 There are a few pharmacological treatments that are preferred for social phobia. One of the most recommended at this moment is Selective Serotonin Reuptake Inhibitors (SSRIs). There has been many reviews, metanalisys that indicate that this drug is effective to treat Social Phobia. It takes approximately 8 to 12 weeks to have a response. All SSRIs are generally welltolerated and effective in the treatment of social phobia (Schneier, 2001). However, side effects such as nausea, sweating, headaches, sedation, weight gain and sexual dysfunction including decreased libido, abnormal ejaculation and impotence are possible. Incidence of side effects differ among products. (zal, 2003) But relapse does happen with more frequency when not combined with therapy. However this drug is also recommended because it seems to be not as addictive to other drugs. Example of these drugs are Prozac, Zoloft, Paxil etc. These drugs are also efficient in treating Comorbid disorders, like depression. Monoamine Oxidase inhibitors was the drug of choice before SSRIs but because of the strict diet that is required in order to avoid adverse reactions they are reserved for certain clients who have not responded to other treatments. Other drugs that are also used; RIMAs, Beta Blockers, Anticunvulsants, Benzodiazepanes. (Curti, 2004; Zal, 2003; Shneier, 2003; Saeed, 2009.) Although there are many trials and investigations that suggest that medication is one of the most effective treatments, it is also clear that without therapy, preferably CBT combined with ET will not last and have a high rate of relapse. The best established treatments for social anxiety disorder are cognitive behavior therapy and serotonin reuptake inhibitors (Sheier, 2003). We can conclude that Social Phobia has to be treated in all aspects, physiological and psychological. Also, medication in children and children has not been thoroughly investigated; and as we know SP starts at an early age. Social phobia is a chronic but treatable disorder. Although there must be more investigation towards treatment for children, teenagers and adults in general. We can conclude

Social Phobia Treatments 8 that the most effective way of treating SP is with therapy and medicine combined. But the assessment of the client is of major importance when choosing the right therapy for them.

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Social Phobia Treatments 11 Wagner, C. G. (1998). Cures for Social Phobia. The Futurist , 32 (9), 6. Retrieved http://go.galegroup.com.ezproxylocal.library.nova.edu/ps/retrieve.do?sgHitCountType=None&so rt=RELEVANCE&inPS=true&prodId=GPS&userGroupName=novaseu_main&tabID=T002&sear chId=R2&resultListType=RESULT_LIST&contentSegment=&searchType=BasicSearchForm&cu rrentPosition=1&contentSet=GALE%7CA53368725&&docId=GALE|A53368725&docType=GAL E&role=ITOF Worcester, S. (2011). Social Phobia in Youth: More than just shyness. Family Practice News , 41 (18), 23. http://go.galegroup.com.ezproxylocal.library.nova.edu/ps/retrieve.do?sgHitCountType=None&so rt=RELEVANCE&inPS=true&prodId=GPS&userGroupName=novaseu_main&tabID=T002&sear chId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=BasicSearchForm&cu rrentPosition=1&contentSet=GALE%7CA278759797&&docId=GALE|A278759797&docType=G ALE&role=ITOF Zal, H. M. (2003). Social Phobia: Treatment Issues. Psychiatric Times , 20 (6), 80. Retrieved: http://go.galegroup.com.ezproxylocal.library.nova.edu/ps/retrieve.do?sgHitCountType=None&so rt=RELEVANCE&inPS=true&prodId=GPS&userGroupName=novaseu_main&tabID=T002&sear chId=R11&resultListType=RESULT_LIST&contentSegment=&searchType=BasicSearchForm&c urrentPosition=1&contentSet=GALE%7CA199396925&&docId=GALE|A199396925&docType= GALE&role=ITOF